CARDIA ECHO RC CAN 9-8470189

约翰霍普金斯大学担任2009- 2013年期间青年人冠状动脉风险发展（CARDIA）研究的超声心动图阅读中心。CARDIA是一项以人群为基础的观察性研究，研究对象是不同社会经济地位的非洲裔美国人和白色男性和女性，研究始于1985- 1986年，研究对象是5115名18-30岁的年轻人。在第2年、第5年、第7年、第10年和第15年的随访检查实现了高保留率，收集了一组丰富的高质量数据并储存了与心血管疾病（CVD）病因有关的标本，并导致了168篇同行评议的出版物。在未来5年内，我们将继续每半年进行一次电话联系、疾病事件监测以及分析和出版活动。我们将对38-50岁的同龄人进行20年的考试。我们建议重新检查至少73%的幸存者（研究范围内的3650名参与者），主要目标有4个： 1)为了确定亚临床动脉粥样硬化发生和进展的预测因素，我们将测量危险因素水平（已确定的、新的、生活方式和心理社会）和亚临床动脉粥样硬化（冠状动脉钙化[CAC]和颈动脉内膜中层厚度[IMT]）。我们将研究危险因素的前因，特别关注日益增长的肥胖流行，探讨近期和远期危险因素暴露对CAC、CAC进展和IMT的影响，并评估肥胖、糖尿病和肾功能损害等疾病的作用，以及社会经济地位和医疗保健获得和利用的差异。 2)为了阐明CVD发病机制中可能存在的种族差异，我们将比较不同风险性别组中与CAC发病率和患病率以及IMT患病率相关的因素。我们将探讨可能解释观察到的差异的因素。 3)为了检测炎症是否先于亚临床疾病，我们将研究炎症标志物（如C反应蛋白）与动脉粥样硬化的CAC和IMT证据之间的相关性。我们还将确定炎症（如感染）的预测因子，以及肥胖和内脏肥胖的影响。 4)为了评估遗传变异和基因与环境相互作用在CVD发病机制中的作用，我们将探讨它们在危险因素病因学中的作用，并检测基因中的等位基因变异，如调节肥胖、高脂血症、血压和骨矿化的基因，是否与CAC和IMT相关。 此外，下一次检查将研究参与者子集的脑磁共振成像（MRI）。 这些数据，以及在单独资助的辅助研究中的发现，将使我们能够检查不同人群中亚临床动脉粥样硬化的前因和患病率。我们将分析易感遗传特征在行为和生理风险因素存在下的作用，以检测基因型与环境的相互作用，并研究这些在男性和女性，非洲裔美国人和白人中的差异。 这些活动将充分利用CARDIA优秀的数据库和标本库、研究人员团队、组织结构和质量控制程序。该研究通过让新的科学家参与CARDIA，扩大了为设计、分析和出版活动做出贡献的研究者队伍，并加强了CARDIA数据的传播和对非附属研究者的分析支持。这些计划将加速我们对中年危险因素和亚临床疾病20年前因的理解。这些知识是设计预防医学政策所必需的，这些政策可以解决日益增长的肥胖症流行病，减少心血管疾病的公共卫生负担，并针对特定的人群亚群和环境进行调整，使其最有效。

Johns Hopkins University serves as the Echocardiography Reading Center for the Coronary Artery Risk Development in Young Adults (CARDIA) Study for the period 2009-13. CARDIA is a population-based observational study of African-American and white men and women of diverse socioeconomic status that began by examining 5115 young adults aged 18-30 in 1985-6. Follow up examinations at years 2, 5, 7, 10, and 15 achieved high retention rates, collected a rich set of high quality data and stored specimens bearing on the causes of cardiovascular disease (CVD), and led to 168 peer-reviewed publications. During the next 5 years we will continue semi-annual telephone contacts, disease event surveillance, and analysis and publication activities. We will carry out a year 20 exam on our cohort, who will be 38-50 years old. We propose to re-examine a't least 73% of those surviving (3650 participants study-wide) with 4 main objectives: 1) To identify predictors of development and progression of subclinical atherosclerosis, we will measure risk factor levels (established, novel, lifestyle, and psychosocial) and subclinical atherosclerosis (coronary artery calcification [CAC] and carotid intima-media thickness [IMT]). We will examine the antecedents of the risk factors with special attention to the growing epidemic of obesity, explore the effects of recent and remote risk factor exposure on CAC, on CAC progression, and on IMT, and assess the role of conditions such as obesity, diabetes and renal impairment, and of differences in socioeconomic status and health care access and utilization. 2) To elucidate possible racial differences in CVD pathogenesis, we will compare the factors associated with CAC incidence and prevalence, and with IMT prevalence, across risk-gender groups. We will explore factors that may explain observed differences. 3) To test whether inflammation precedes subclinical disease, we will examine the time course of the association between inflammatory markers (such as C-reactive protein) and CAC and IMT evidence for atherosclerosis. We will also identify predictors of inflammation (such as infection), and the impact of obesity and of visceral adiposity. 4) To assess the roles of genetic variation and gene by environment interactions in CVD pathogenesis, we will explore their role in the etiology of risk factors, and test if allelic variation in genes such as those regulating obesity, hyperlipidemia, blood pressure, and bone mineralization are associated with CAC and IMT. Additionally, the next examination will study the Brain Magnetic Resonance Imaging (MRI) in a subset of the participants. These data, as well as findings in separately funded ancillary studies, will allow us to examine the antecedents and prevalence of subclinical atherosclerosis in diverse populations. We will analyze the role of predisposing genetic traits in the presence of behavioral and physiologic risk factors in order to detect genotype-by-environment interactions, and to study how these differ in men and women, and in African-Americans and whites. These activities will take full advantage of CARDIA's outstanding database and specimen bank, and team of investigators, organizational structure, and quality control procedures. The study expands the pool of investigators contributing to design, analysis and publication activities by involving new scientists in CARDIA, and enhances dissemination of CARDIA data and analytic support to non-affiliated investigators. These plans will accelerate the growth of our understanding of the 20-year antecedents of middle-aged risk factors and subclinical disease. This knowledge is needed for designing preventive medicine policies that address the growing epidemic of obesity and reduce the public health burden of CVD, and that are tailored to specific population subgroups and settings where they will be most effective.